Uninsured Ranks Still Growing

WASHINGTON -- Almost half of working adults were uninsured or underinsured at some point last year -- a percentage that continues to grow, the Commonwealth Fund, a liberal think tank, reported in a survey released Friday.

Roughly 30% of adults ages 19 to 64 went without health insurance for part or all of 2012, nearly 10 million more people than the 26% who went without coverage in 2003, the organization's Biennial Health Insurance Survey found.

An additional 16%, or 30 million people, were considered "underinsured" -- they had insurance but also had out-of-pocket costs so high it was considered a barrier for them. Underinsured was defined as out-of-pocket expenses that reached 10% or more of income -- 5% or more if income was below 200% of the federal poverty level -- or deductibles that were 5% or more of income.

Although the number of underinsured people was still high, it leveled off in the last 2 years in part because of the slowdown in the rise of health costs, the authors noted.

The continual rise in the number of uninsured people signals the need for the full implementation of the Affordable Care Act (ACA), Commonwealth Fund President David Blumenthal, MD, said.

"Our expectation is that we will begin see positive changes in our healthcare system when the major coverage provisions launch in 2014," Blumenthal told reporters on a conference call. "But the changes won't happen overnight."

Almost 90% of the 55 million uninsured would be eligible for subsidized health insurance through the ACA's health insurance exchanges, or for its expanded Medicaid program, the New York City-based Commonwealth Fund said.

One bright spot from the findings was that the number of young adults -- those age 19-25 -- who were uninsured during the year fell from 48% in 2010 to 41% last year, a drop of 1.9 million people. The Commonwealth Fund credited the decline to an ACA provision -- in effect since 2010 -- that allows dependents to remain on a parent's health plan up to age 26.

Sara Collins, Commonwealth Fund vice president and the study's lead author, said cost protections in the ACA will help. For example, people with incomes up to 250% of the federal poverty level are eligible for coverage with lower deductibles and copayments. The ACA's exchanges will be open to people making between 100% and 400% of poverty who are without employer-sponsored coverage.

The Commonwealth Fund also found continuing problems with the affordability of healthcare. In 2012, an estimated 80 million didn't go to the doctor when they were sick or didn't fill a prescription because of costs -- a number that's up from years past.

Another 75 million people (41%) had problems paying their medical bills or were paying medical bills over time, up from 58 million in 2005, the survey found.

"The cost of healthcare and health coverage in the United States has been on an unsustainable, upward trajectory for several decades, straining government and family budgets," Blumenthal said. "It's important that lawmakers and regulators across the country take the steps required to assure that all Americans can benefit fully from the law's improvements to quality, efficiency, and affordability of our healthcare system."

The survey consisted of 25-minute telephone interviews from a random, nationally representative sample of more than 4,400 adults. The margin of error was 2.3%.

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